Determinants of Suboptimal Peak Inspiratory Flow Rates among Patients with Chronic Obstructive Pulmonary Disease in Southwest, Nigeria.

BACKGROUND: Inhalational therapy is the cornerstone in the management of chronic obstructive pulmonary disease (COPD) patients. Patients' peak inspiratory flow impacts effective dry powder inhaler (DPI) delivery and management outcome. OBJECTIVE: This study assessed peak inspiratory flow rates (PIFR) and determined the factors associated with suboptimal inspiratory flow rates among COPD patients. METHODS: A descriptive cross-sectional study was conducted among 60 participants (30 stable COPD patients and 30 age-and-sex matched controls). Socio-demographic characteristics was obtained and spirometry was done for all participants. PIFR assessment was done using the In-Check Dial Meter and was categorized as suboptimal (< 60L/min) or optimal (≥ 60L/min). P values less than 0.05 were taken as statistically significant. RESULTS: Mean age of the COPD patients and healthy controls were both 67.8 ± 10.3 years, with 53.3% being females. Post-bronchodilation FEV 1/FVC% for COPD patients was 54.15 ± 11.27%. The mean PIFR among COPD patients was significantly lower than that of healthy controls, in all DPIs simulated, especially for Clickhaler (46.2±13.4 vs 60.5±11.4L/min, p<0.001). A significant proportion of COPD patients had suboptimal PIFR, in the simulated resistances against Clickhaler and Turbuhaler (70% vs 80%; p<0.001). Older age, shorter height and low BMI were associated with suboptimal PIFR among COPD patients. However, independent predictors of suboptimal PIFR were BMI, PEFR, FEV1% and FVC%. CONCLUSION: Suboptimal PIFR was found in a significant number of COPD patients when compared with healthy respondents. Routine assessment using In-Check Dial meter should be done to determine the suitability of dry powder inhalers for patients with COPD.

CONTEXTE: Le traitement par inhalation est la pierre angulaire de la prise en charge des patients atteints de bronchopneumopathie chronique obstructive (BPCO). Le débit inspiratoire de pointe des patients a une incidence sur l'efficacité de l'inhalateur de poudre sèche et sur les résultats de la prise en charge. OBJECTIF DE L'ÉTUDE: Cette étude a évalué les débits inspiratoires de pointe et déterminé les facteurs associés aux débits inspiratoires sousoptimaux chez les patients atteints de BPCO. MÉTHODES: Une étude transversale descriptive a été menée auprès de 60 participants (30 patients atteints de BPCO stable et 30 témoins appariés selon l'âge et le sexe). Les caractéristiques socio-démographiques ont été recueillies et une spirométrie a été effectuée pour tous les participants. L'évaluation du PIFR a été réalisée à l'aide du Dial Meter In-Check et a été catégorisée comme suboptimale (< 60L/min) ou optimale (≥ 60L/min). Les valeurs P inférieures à 0,05 ont été considérées comme statistiquement significatives. RÉSULTATS: L'âge moyen des patients atteints de BPCO et des témoins sains était de 67,8 ± 10,3 ans, avec 53,3 % de femmes. Le pourcentage de VEMS/FVC après bronchodilatation chez les patients atteints de BPCO était de 54,15 ± 11,27 %. Le PIFR moyen des patients atteints de BPCO était significativement plus faible que celui des témoins sains, pour tous les DPI simulés, en particulier pour le Clickhaler (46,2±13,4 vs 60,5±11,4L/min, p<0,001). Une proportion significative de patients atteints de BPCO avait un PIFR sous-optimal, dans les résistances simulées contre Clickhaler et Turbuhaler (70% vs 80% ; p<0.001). L'âge avancé, la petite taille et un faible IMC étaient associés à une PIFR sous-optimale chez les patients atteints de BPCO. Cependant, les prédicteurs indépendants du PIFR suboptimal étaient l'IMC, le DEP, le VEMS et la CVF. CONCLUSION: Un nombre significatif de patients atteints de BPCO présente un PIFR sous-optimal par rapport aux personnes interrogées en bonne santé. Une évaluation de routine à l'aide de l'appareil de mesure In-Check Dial devrait être effectuée pour déterminer si les inhalateurs de poudre sèche conviennent aux patients atteints de BPCO. Mots clés: Inhalateur de poudre sèche, Débit inspiratoire maximal, Fonction pulmonaire.

The Prevalence and Factors Associated with Depression among Patients with Pulmonary Tuberculosis at the Federal Medical Center, Owo, Nigeria.

BACKGROUND: Co-morbid depression poses a challenge to the successful management of pulmonary tuberculosis (TB). This study assessed the prevalence of depression and its associated factors among patients receiving treatment for TB in a tertiary health care facility in southwestern Nigeria. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted among all the pulmonary TB patients presenting in the initiating or continuous phase of treatment and they were consecutively recruited between January and December, 2017. The Mini International Neuropsychiatric Interview (MINI) tool was used for the diagnosis of depression. The severity of depression was assessed using Hamilton Rating Scale for Depression (HAMD). RESULTS: Of the 152 patients, 85 (55.9%) were males with a mean age of 41.7 ±15.5 years and 71 (46.7%) had depression of which 64(90.1%) had mild depression and 2 (2.8%) had severe depression. Among female 38(56.7%) were depressed compared to 33 (38.8%) male (p=0.028). Fifty-nine (55.1%) of those on continuous phase of treatment were depressed compared to 12 (27.3%) initiating treatment (p=0.002). In those with HIV co-morbidity 36 (66.7%) were depressed while 35 (35.7%) were depressed among those without HIV co-morbidity (p <0.001). Among those who had poor perception of treatment outcome, 7 (87.5%) were depressed compared to 64 (44.4%) with good perception, p=0.018. Overall, predictors of depression were having poor perception about outcome of treatment (AOR: 12.9; CI 95%: 1.4-118.4), having HIV co-morbidity (AOR: 2.9; CI 95%: 1.4-6.3) and being on continuous phase of TB treatment (AOR: 2.5; CI 95%: 1.1- 5.9). CONCLUSION: The care of patients with TB should be more comprehensive. Health care workers should actively seek for evidence of depression among patients diagnosed with Tuberculosis and appropriate help offered to them.

Impact of Sleep Quality on Asthma Control amongst Asthmatics at Federal Medical Centre, Owo, Ondo State.

BACKGROUND: Poor sleep quality is reportedly common among asthmatic patients, however, there is little or no data among Nigerian asthmatics. The purpose of this study was to determine the contribution of sleep quality to Asthma control OBJECTIVE-To determine the impact of sleep quality on asthma control amongst asthma patients at Federal Medical Centre, Owo, Ondo State. METHODS-This was a cross sectional study evaluating 100 clinically stable asthmatic patients at the outpatient department at Federal Medical Center, Owo. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and Daytime sleepiness was assessed using the Epworth sleepiness scale (ESS). Asthma control was assessed by Asthma Control Test (ACT) score. Peak Expiratory Flow variability (PEF) was used to determine average daily variability in lung expiratory flow and this was used to monitor asthma control and severity over a period of two weeks. Additionally, lung function was assessed by spirometry. RESULTS: The mean age of the study population was 45.2 ± 17. 5years. Sixty patients (60%) had poor quality of sleep (PSQI > 5), while fifty-three patients (53%) had excessive daytime sleepiness (ESS>9). Increasing global PSQI score (poor sleep quality) was associated with decreasing ACT score (poor asthma control) with (r=-0.63; p <0.001). Multiple regression analysis showed that quality of sleep was the independent predictor of asthma control in our patients (p= <0.001). CONCLUSION: Results from this study suggest that quality of sleep is a significant determinant of asthma control in asthmatic patients. Therefore, efforts should be made to screen patients with asthma for sleep impairment.

Economic Cost of Asthma and Psychiatric Morbidity in Nigerian Patients with Asthma.

BACKGROUND: Asthma is known to constitute a huge economic burden to its sufferers and their carers. There is a dearth of studies documenting this burden among asthmatics in Nigeria. OBJECTIVE: This study assessed the relationship between economic cost and psychiatric morbidity among stable Nigerian patients with asthma. METHODS: 85 patients with asthma completed a socio-demographic and illness-related questionnaire, the modified Economic Cost Questionnaire and General Health Questionnaire 12 (GHQ 12). Associations between socio-demographic characteristics, illness related variables, psychiatric morbidity and the direct, indirect and total costs in relation to asthma were assessed. RESULTS: The average annual total, direct and indirect cost were $309, $190.65 and $118.34 respectively per patient for subjects with asthma. Direct cost constituted 62.7% while the indirect cost was 38.3% of the total cost for asthma. Drugs and hospitalisation were leading contributors to direct costs for asthma. Psychiatric morbidity was found to be present in 35% of subjects with asthma, those with psychiatric morbidity had a higher economic burden. CONCLUSION: The economic cost of asthma is high, psychiatric morbidity increases this cost. The cost is largely due to drugs and hospitalisations for exacerbation. There is an urgent need to optimize means of helping to minimize this cost and increase measures for detecting and treating psychiatric morbidity.

Cognitive Functions in Patients with Clinically Stable (Mild to Moderate) Asthma in South West Nigeria: Assessment using Automated Neuropsychological Test Battery.

OBJECTIVE: Previous reports has shown that asthmatic patients with poor asthma control exhibited cognitive dysfunction. However, there is paucity of information on the cognitive functions of patients with clinically stable asthma particularly in sub-Saharan Africa. Subjects, study setting, materials and methods: This was a cross-sectional study conducted at the Federal Medical Centre, Owo, South West Nigeria from 2014-2016. Forty patients with mild to moderate asthma and forty matched (age, sex and educational status) non-asthmatic control subjects were included. Spirometry was done for all participants. Cognitive performance on domains of psychomotor speed, attention/concentration, memory and vigilance were assessed in all the participants using the Fepsy neuropsychological test battery Results: The mean age of the patients with asthma in years was 38.65±16.67 while that of the control subjects was 39.18±11.64 years. The patients with asthma had prolonged visual and binary choice reaction time relative to controls. Older asthmatic patients had prolonged visual and binary choice reaction time when compared to controls (p<0.05) while other socio-demographic clinical characteristics of the patients did not have impact on their cognitive performance (p>0.05). CONCLUSION: Cognitive performance was similar between the patients with mild to moderate asthma and non-asthmatic controls. Older asthmatic patients have impaired psychomotor speed relative to younger asthmatic patients.

Tuberculosis treatment outcomes and interruption among patients assessing DOTS regimen in a tertiary hospital in semi-urban area of south-western Nigeria.

BACKGROUND: Tuberculosis remains one of the most infectious diseases worldwide especially with the HIV pandemic. It is a cause of high morbidity and mortality in developing countries including Nigeria. Reasons contributing to high morbidity and mortality include high defaulting rate and treatment interruption. Several studies had evaluated the treatment outcome of tuberculosis but there is paucity of published literature on the outcome of treatment interruption especially in this environment. This study thus assessed the outcome of treatments and interruption among patients assessing DOTS regimen in a tertiary hospital located in asemi urban area in south-western Nigeria. METHODOLOGY: The study was a review of TB register of the federal medical centre, Owo from its inception in 2008 to 2011. All the patients that have completed at least one course of chemotherapy (defined as 8 months of anti-tuberculosis treatment- 2 months intensive phase and 6 months continuation phase) were included. Treatment outcome and interruption were defined in accordance with World Health Organisation (WHO) recommendations. Data were analysed with SPSS version 17. RESULTS: A total of 400 patients were included. The mean age of patients was 36.8 +/- 16.8 years and 56.3% were male. Majority, (79.7%) were adults aged 19-64 years, 12.5% were in the paediatric age group and 7.8% were elderly. Less than half, 45.3% had TB/HIV co-infection. Regarding treatment outcome of tuberculosis, 75.5% were cured, 14.8% died, 4% relapsed and 3% defaulted. A little above one-fifth, 21 (5.3%) had treatment interruption among whom 9 (42.9%) were successfully traced and completed treatment. Significantly, higher proportion of those that had treatment interruption died, 54.1% compared with their counterpart, 14.9%, (p < 0.001) and had relapse. (14.3% versus 3.4%, p = 0.01). CONCLUSION: A high rate of tracking failure among patients with treatment interruption was found in the study. In addition, mortality and morbidity were higher among patients with treatment interruption. A more concerted effort is needed in tracking/tracing patients with treatment interruption in orderto reduce morbidity and mortality among TB patients assessing treatment.

The Asthma Control Test and its Relationship with Lung Function Parameters

The Asthma Control Test (ACT) is a validated, simple,and inexpensive instrument to assess control among patients with bronchial asthma. However, its relationship with lung function parameters is yet to be demonstrated among Nigerian asthma patients. Our study aimed at assessing asthma control using ACT scores and determining its relationship with lung function parameters among persons with asthma in a university respiratory clinic.The cross-sectional study included 65 patients with bronchial asthma who underwent routine check-ups in respiratory clinics at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria between October 2009 and January 2011. The ACT was administered to assess for asthma control. Lung function testing was done using the guidelines of the American Thoracic Society (ATS).The mean pre-bronchodilator FEV1 (forced expiratory volume in 1 second) was 1.97±0.87L and mean ACT score was 18.2+4.28; 24 (37%) of the study subjects had well-controlled asthma. The ACT scores were weakly correlated with percentage of predicted,FEV1(r=0.220, p=<0.078) and PEF (peak expiratoryflow), (r=0.168,p=0.18).In this study, most of the patients had poor asthma control and lung function parameters correlated poorly with ACT scores. It is important that the ACT complements other physiological measures of assessing asthma control in our environment

Health-related quality of life among patients with bronchial asthma in Ile-Ife, Nigeria

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